Pay down, oversight up: Twin threat to urologists

The message is clear. The 2015 Urology Times State of the Specialty survey shows urologists are being driven to do more each year with less reward and greater overhead. We deal with mounting paperwork in the form of PQRS reporting, electronic prescriptions, EHR meaningful use criteria, and pre-authorizations, but also lower reimbursement and higher rates of denials. 

Yet, there are no data to show this increased oversight improves outcomes or quality, decreases risks to patients, or increases value. Of course, much of this is financially driven. A certain percent of denials will never be appealed, saving payers money.

This year’s survey results reflect growing physician discontent similar to previous surveys but perhaps felt more deeply. We are working longer hours (80% work over 40 hours weekly) but receiving less reimbursement (55% report a decrease from 2013 to 2014). This picture is clear across all ages, years of experience, geographic regions, and practice styles. Physicians are very worried about loss of revenue, loss of autonomy, demands for pre-authorization, pressure to keep up with patient load, government regulations, reporting quality measures, increasing overhead in general, and new demands made under the Affordable Care Act to move to alternative practice models.

In fact, 42% of physicians say MACRA (which abolished the sustainable growth rate) actually made their outlook worse.

Only 25% are satisfied or very satisfied financially, although nearly half are satisfied professionally. Even though we are the second-oldest specialty, 63% plan to retire between 60 and 70, creating serious work force challenges that threaten access to quality urologic care. In fact, if they could afford it, 56% say they would retire now.

Many voiced concerns and complaints about maintenance of certification requirements, a subject for a future article. Many do not want to continue to participate, and 45% plan to retire because of this. Since 36% of responders are over 60, this is a serious threat.

These results are no surprise to anyone listening to physicians grumbling in the doctors' cafeteria. Fee for service is not dead, but it is increasingly frustrating and decreasingly rewarding financially. As a whole, urologists are not a happy bunch, and many are looking to leave their practice or adapt to new practice models.

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